Multivariable Association Between Changes in Medicaid Reimbursements for Vaccine Administration and Receipt of Influenza Vaccinationa
| Coeff (95% CI) Vaccine Admin with Counseling, CPT 90460 (pct points) | Coeff (95% CI) Vaccine Admin without Counseling, CPT 90471 (pct points) | |
|---|---|---|
| Medicaid reimbursement ($1 increase) | 0.1 (−0.1, 0.3) | 0.05 (−0.1, 0.2) |
| Age (years) | −1.5 (−2.1, −0.8) | −1.5 (−2.1, −0.8) |
| Year (observation year) | 1.0 (0.4, 1.5) | 0.9 (0.3, 1.5) |
| Sex | ||
| Male | (ref) | (ref) |
| Female | 0.5 (−1.3, 2.4) | 0.5 (−1.3, 2.4) |
| Race | ||
| White | (ref) | (ref) |
| Black, non-Hispanic | 2.0 (−0.9, 4.9) | 2.0 (−0.8, 4.9) |
| Hispanic | 3.5 (1.0, 6.0) | 3.5 (1.0, 6.1) |
| Other, non-Hispanic/multi-race | 4.6 (1.4, 7.7) | 4.6 (1.4, 7.7) |
| Poverty status | ||
| Above poverty | (ref) | (ref) |
| Below poverty | 0.4 (−1.6, 2.4) | 0.4 (−1.6, 2.4) |
| Missing | −1.1 (−5.6, 3.5) | −1.1 (−5.6, 3.5) |
| Mother’s age | ||
| ≤34 | (ref) | (ref) |
| 35 to 44 | −0.08 (−2.7, 2.6) | −0.08 (−2.7, 2.6) |
| ≥45 | 2.0 (−0.9, 4.9) | 2.1 (−0.8, 5.0) |
| Mother’s marital status | ||
| Married | (ref) | (ref) |
| Not married | −4.0 (−6.0, −2.1) | −4.0 (−6.0, −2.1) |
| Number of visits to doctors in a previous year | ||
| None | (ref) | (ref) |
| 1 | 2.8 (0.2, 5.5) | 2.9 (0.2, 5.5) |
| 2+ | 9.4 (7.1, 11.8) | 9.4 (7.1, 11.8) |
| Facility type for teen’s vaccination providers | ||
| All private | (ref) | (ref) |
| All public | −5.9 (−8.3, −3.6) | −5.9 (−8.2, −3.6) |
| All hospital | −2.5 (−5.9, 1.0) | −2.5 (−5.9, 1.0) |
| All STD/School/Teen clinic/other | −4.5 (−11.2, 1.7) | −4.8 (−11.2, 1.7) |
| Mixed | 0.5 (−2.1, 3.1) | 0.5 (−2.1, 3.1) |
| Missing | −3.9 (−7.5, −0.3) | −3.9 (−7.5, −0.3) |
| Medicaid Expansion status | ||
| Not expanded | (ref) | (ref) |
| Expanded | −1.5 (−5.3, 2.4) | −1.4 (−5.2, 2.5) |
| Managed Care penetration rate | −1.9 (−6.9, 3.1) | −1.2 (−6.1, 3.7) |
↵a Adjusted multivariable regression model also includes adjustment for Medicaid vaccination reimbursements (in US$), state fixed effects for states with reliable data (CO, CT, IA, ID, MA, MI, MN, MO, MS, MT, NH, NM, NV, OK, SC, TX, VT, WY). Medicaid Managed Care penetration rates for children in comprehensive Medicaid plans in states with reliable data were obtained from Medicaid and CHIP Payment and Access Commission (MACPAC) reports.30 Medicaid expansion status was determined by whether a state expanded Medicaid in each year between 2014-2019. The models also included a random effect at the person level.
Abbreviations: STD, sexually transmitted disease; CI, confidence interval; CPT, current procedural terminology.